Successful removal of a large goitre : with remarks / by Edward Jessop and James Berry.

  • Jessop, Edward.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: Successful removal of a large goitre : with remarks / by Edward Jessop and James Berry. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Uiis time. The temperatme in the evening afler tlie operation was 99°, and the pulse 92. Tlie next morning the temperature was 100°, and the pulse 102 ; afler this, the temperature was always normal, and the pulse never rose above 100. The dress- ings were left undistuihed until the third day (April 18), when the wound was dressed, the drainage-tube and all sutures being removed, as the wound was practically healed. The relief afforded hy the operation was marked. On the day following, the patient had a little pain in the neck and slight difficulty in swallowing. The respiratory trouble almost entirely disappeared at once. The pain and dys{)hagia passed off in a day or two. On the fourth day he was allowed to get up for a short time, atid to have a little solid food. On the eighth day (April 23) all dressings were discontinued. The patient’s condition on the tenth day after the operation is depicted in fig. 2; on the twelfth, in fig. 3. After leaving the Hospital the enlargement of the right lobe continued to diminish ; it then slowly increased in size to a certain extent, as is usual in such cases. But th.e relief has been so complete that he has ever since been able to do the hard work of a farm-laboui er.^ Pathological appearance.—The tumour aftei- removal weighed 18 ounces. It comprised the whole of the left half of the thyroid gland.^ It proved to be an innocent multilocular cystic tumour with solid nodules of a fibro-adenomatous nature. Immediately under the capsule lay numerous large veins and arteries, many of the former being as thick as goose-quills. These veins in the specimen have been injected with coloured plaster- of-paris, the arteries with red, and the veins with blue. The surface of the mass was irregulaily lohulated, preset)ting here and there an indistinct sense of fluctuation. On section, the appearances presented were those shown in fig. 4. The tumour has been laid open vertically from the front, and the two halves turned aside to show the interior. At the upper part is a tolerably firm, elastic, largely fibrous, solid nodule with a definite capside. Below this are several large cysts with tough fibrous walls, each containing colloid matter mixed with blood. In some of the cysts the contents were nearly solid, and in others had the consistency of treacle. The cysts were separated 1 Since my removal to Hampstead I have not had an opportunity of seeing the patient again, but I have recently (October 1889/ heard by letter from him, and the improvement in his condition has been permanent.—E. J. ^ The tumour, bisected, is preserved in the Museums of the Royal College of Surgeons (No. 2908, F.) aud of St. Bartholomew’s Hospital (No. 2310, c.) ; a cast of the patient’s neck before operation is also in the latter Museum (No. 138, g.)-